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e <br /> (0 1t� <br /> _ Dane County Department of Planning & Development <br /> y Application for Density Study Report <br /> lysy <br /> csicorisv <br /> Date: ///7A <br /> Landowner information: <br /> Name: 6--e o .�/e �,e 6 <br /> Address: /� 3 Sc� c ci £.? City: 4 c e I! Zip Code: s ,S ' <br /> Daytime phone: <br /> Fax: E-mail: <br /> Applicant information (if different from landowner): <br /> Name: lG,tfa¢>;4.-- a ie,e se la <br /> Address: d 6 dx ) City: „ • ice P Zip Code: ,�,,5 Z'� <br /> Daytime phone: rd - Z3 3r-<--- <br /> Fax: ,D" „• E-mail: U /1 r @ ,fea, f `pie io. �D`-v--t <br /> Relationship to landowner: ii`r ' • (._/(2 <br /> Are you submitting this application as an authorized/ gent for the landowner? Yes J No <br /> Property information: ,` / / <br /> Property address: 75 7 $c t c iGl ogi - - <br /> Parcel ID#:�/r �// –167 - 99ea7'-7 p/8' r17/ -31e3- 5--Z— <br /> Legal description of property: <br /> 1/4 of 1/4, Section , Town of ( 'H'41"- (T/rLe d <br /> OR <br /> Certified Survey Map ID: Lot <br /> Sketch map provided? Yes 0 No O <br /> Additional information (optional): <br /> Name of owner of original farm (if known): <br /> Are there any recorded agreements, liens, deed restrictions, easements or.othu legally binding <br /> documents that would affect the number or distribution of potential buildi iites tan the piOpOrteir ri,. <br /> Yes 0 Reg. of Deeds Doc. No (if known) !.;, ,1 r I) <br /> ' <br /> No (0 <br /> Don't know 0' NOV 2 1 2016 <br /> Comments: ' <br /> Please allow 3-6 weeks to process your request. A copy of the report will be mailed to the landowner, <br /> the applicant(if different from the landowner) and the town clerk. <br />